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Annals of Surgical Oncology

Patterns, Timing, and Survival of Recurrence After Surgery for Esophageal and Junctional Adenocarcinoma in the European Multicentre ENSURE Study

Authors
Lucas Goense, MD, PhD
Jessie A. Elliott, MD, MRCS, PhD
Sheraz R. Markar, MD, MRCS, PhD
Fredrik Klevebro, MD, PhD
Asif Johar, PhD
Styliani Mantziari, MD
 Pernilla Lagergren, PhD
Giovanni Zaninotto, MD
Richard van Hillegersberg, MD, PhD
Mark I. van Berge Henegouwen, MD, PhD
Magnus Nilsson, MD, PhD
George B. Hanna, MD, PhD, FRCS
John V. Reynolds, MD, FRCS
ENSURE Study Group
Published in
Annals of Surgical Oncology

Abstract

Background

Following surgery for esophageal cancer, approximately half of patients develop disease recurrence. Analyzing recurrence site, timing, and their impact on postrecurrence survival can guide refinements in postoperative surveillance and therapy. This study aimed to describe the pattern and timing of esophageal cancer recurrence and assess survival patterns by recurrence location.

Methods

This study included patients from the ENSURE study who underwent resection for esophageal and junctional adenocarcinoma between 2009 and 2015 across 20 centers in Europe and Canada. Only patients with disease recurrence were included in the final analysis. Sites of first recurrence were stratified into different groups and survival outcomes postrecurrence detection were estimated using Kaplan-Meier curves.

Results

Of 3,299 patients who underwent surgery for esophageal adenocarcinoma, 1,310 patients developed recurrence and had sufficient follow-up data available. First recurrence was detected at multiple distant sites (n = 469; 37.3%) or at a single distant site (n = 463; 33.7%), whereas isolated local recurrence occurred in 189 (14.4%) patients. Recurrence in the liver-only presented significant earlier (median 9.0 months), whereas recurrence in lung-only (15.2 months) and local-only recurrence (17.8 months) were observed later. Patients with multiple-sites and liver-only recurrence had significant worse median postrecurrence survival (7.4 and 8.3 months, respectively) compared with lung- or local-only recurrence (10.4 and 15.9 months, respectively).

Conclusions

This study highlights that time to recurrence varies by location and significantly impacts postrecurrence survival outcomes. Multiple sites and liver-only recurrence had the poorest prognosis.
Title
Patterns, Timing, and Survival of Recurrence After Surgery for Esophageal and Junctional Adenocarcinoma in the European Multicentre ENSURE Study
Authors
Lucas Goense, MD, PhD
Jessie A. Elliott, MD, MRCS, PhD
Sheraz R. Markar, MD, MRCS, PhD
Fredrik Klevebro, MD, PhD
Asif Johar, PhD
Styliani Mantziari, MD
 Pernilla Lagergren, PhD
Giovanni Zaninotto, MD
Richard van Hillegersberg, MD, PhD
Mark I. van Berge Henegouwen, MD, PhD
Magnus Nilsson, MD, PhD
George B. Hanna, MD, PhD, FRCS
John V. Reynolds, MD, FRCS
ENSURE Study Group
Publication date
06-04-2026
Publisher
Springer US
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-026-19153-8
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